Is cosmetic surgery an appropriate commencement gift for teens?

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Correction: An earlier version of this story incorrectly stated that cosmetic procedures performed on U.S. teenagers had nearly doubled between 2002 and 2006. In fact, according to statistics provided by the American Society of Plastic Surgeons, 244,124 procedures were performed on patients ages 13 to 19 in 2006 compared to 223,673 procedures performed on kids 18 and younger in 2002.

When Courtney Powers graduated from high school last year, she didn’t receive a new computer or a trip to Europe. The North Carolina teen got a pair of D-cup breast implants.

“My breasts hadn’t grown since I was 16,” says Powers, who underwent cosmetic surgery two days after her 18th birthday. “I was a 36AA and my mom and dad knew I was very self-conscious.”

Powers earned half the money for the surgery by working at a bowling alley and baby-sitting. Her parents chipped in the rest as a graduation gift.

Although teens make up just 2 percent of cosmetic surgery patients in the United States, their numbers have grown. In 2006, procedures performed on kids ages 13 to 19 totalled 244,124, including about 47,000 nose jobs and 9,000 breast augmentations, according to the American Society of Plastic Surgeons (ASPS).

But if a teen wants a nip or tuck, should parents comply? And at graduation time, is a boob job or liposuction really an appropriate reward for years of academic achievement?

Living in the now
L. Kris Gowen, an adolescent developmental psychologist at Portland State University, says she worries that many teens aren’t equipped to make decisions that will potentially impact their health and the rest of their lives.

“Adolescents generally ground themselves in the here and now and in more concrete thinking,” she says. “They don’t tend to think of the long-term effects or risks of surgery but, rather, just the concrete result of ‘I’ll look better.’”

And who can say if that Ashlee Simpson nose or DD chest will still be cute in 20 years?

As with any surgery, there are risks, including bleeding and infection. And a fair number of cosmetic surgeries — perhaps as many as 20 percent — must be revised.

There’s also reason to be wary of the psychological state of some surgery candidates, as well as the surgery’s impact on mental health.

Although researchers haven’t concluded surgery can lead to suicide, four epidemiologic studies have found that the risk of suicide among women with breast implants is two- to threefold higher than among other women. One theory is that some people who get surgery are actually suffering from a psychological disorder known as body dysmorphic disorder (BDD), in which they falsely believe they are unusually ugly. A study last year found that suicide rates among patients with BDD was 45 times higher than in the general population.

“We know that from 5 to 15 percent of all cosmetic surgery patients have BDD” and it tends to first emerge in adolescence, says David D. Sarwer, an associate professor of psychology at the Center for Human Appearance at the University of Pennsylvania School of Medicine in Philadelphia.

“Some of these teens who want surgery may be suffering from BDD," he says. "Psychotherapy and [antidepressants] are much more effective for BDD than cosmetic surgery.”
Video: More teens have plastic surgery

Janice Styer, an adolescent counselor in Wernersville, Pa., warns parents to also carefully consider the message surgery sends to kids.

“In working with adolescent females I see this as just another quick fix. The thing that bugs me is the lack of coping skills we’re giving kids. We’re saying, ‘If you can’t meet the expectations of society, just get surgery,’” says Styer.

“By giving teen girls, in particular, surgery we’re just sending this message to them that they can be anything they want to be — they can go to any school or do anything in life — as long as they look a certain way on the outside,” says Courtney Macavinta, co-author of “Respect: A Girl’s Guide to Getting Respect and Dealing When Your Line Is Crossed.”

It’s not the right message to tell them that we’re glad they’re smart, says Macavinta, but now do something about the nose.

“I’m all for taking a shower, combing your hair and getting a cute outfit, but there is only a tiny percentage of people whose profession and success rely on appearance,” says Macavinta. “The girls who thrive and prosper in life very quickly invest their energy other places — like their brains, compassion and humor.”

Sarwer doesn’t wholly agree: “From a societal perspective, the reality is that whether we like it or not, our appearance does seem to matter.”

Studies show that attractive people are treated more favorably and that a positive body image can account for up to one-third of self-esteem, he says.

“Parents who have familiarity with plastic surgery will tend to have children who have more plastic surgery,” says Dr. Brent Moelleken, a Beverly Hills plastic surgeon. “But a reputable doctor will make sure patients aren’t being pushed by their parents, though. Surgery is a serious decision and it works best if the patient is internally motivated — not pressured by a parent or someone else — and has reasonable expectations.”

Atlanta plastic surgeon Dr. Brian Maloney says he's careful during consultations to gauge if the motivation is coming from the teen or from "an overly worried mom who is a socialite and is concerned if a hump on daughter’s nose is going to impact marital prospects down the road.” He often asks to speak with the teen alone to gauge if he or she really wants the surgery.

However, surgeons will admit that sometimes it’s a complicated judgment call.

Take the case of Katie Underdown of Georgia. Last year, the 17-year-old had a nose job and a chin implant by the same surgeon who did multiple surgeries on her mother, Jan, and several of her mom’s friends. Although the teen had a deviated septum, a medical condition that makes it harder to breath, she initially balked at surgery. Her mother urged her on, though.

“I told her, ‘It doesn’t bother you right now but it may later. Let’s just get it fixed.’ I had a great surgeon, I was able to pay for it and nurse her back,” explains Jan Underdown. “Katie had a recessed chin like me and I said, ‘Put the chin implant in.’ She did it. It turned out great. I think of it like her braces. You fix what you know is an issue and then you go on and live your life.”

Although the teen is pleased with the outcome, she’s not enthusiastic about surgery in general. “I think people should be happy with the way they look and shouldn’t feel obligated to have surgery,” she says. “But I will say also that I look better and breathe better now. So in my case it was a good choice.”

Sarwer notes that the majority of adults who undergo plastic surgery also report being satisfied with the outcomes. “Body image improves after surgery. Self-esteem and quality of life can improve as well,” he says. “However, more studies are needed before we can say that kids benefit the same way adults do.”

Courtney Powers doesn’t need any study to convince her. Bathing suit season is rolling around and she’s already ordered two new suits from Victoria’s Secret.

“[The surgery] has made me feel better. Now I have more self-confidence. When I go out … I’m not afraid of my fake padding falling out. I feel like I can look at myself and say, ‘I’m really pretty.’ Before, something seemed like it was missing. Now there’s nothing missing.”

Is she saving for another surgery?

“Not now,” says Powers, “but once you have your first surgery it’s like a huge open door. You do see how easy it is to fix something.”

Victoria Clayton is a freelance writer based in California and co-author of "Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a Mom," published by Fair Winds Press.